Cardioversion (Scheduled Heart Rhythm Shock)

What it is

A heart in atrial fibrillation or flutter is being driven by a disorganized electrical signal that keeps recirculating. A synchronized shock delivered through pads on the chest stops all of that electrical activity for an instant, and the heart's own natural pacemaker usually takes over again as it restarts. Two words in the listing do real work. *Elective* means this was arranged ahead of time for a rhythm that has been going on, which is a different situation from the emergency shock given to someone collapsing. *External* means the current is delivered through the skin, not through a catheter placed inside the heart. Medication can also be used to convert a rhythm; this code is the electrical route.

Why it is done

• To return a heart in atrial fibrillation or flutter to its normal rhythm, where the aim of treatment is rhythm control rather than rate control
• To relieve breathlessness, fatigue, or palpitations that persist despite medication
• To see whether a person feels better in normal rhythm, which helps decide what to do next
• To restore rhythm after it has slipped back following an earlier conversion or an ablation

What to expect

Because a shock to a heart that has been out of rhythm for a while can dislodge a clot, clinicians generally arrange blood-thinning treatment or an imaging check of the heart beforehand — that preparation is often the longer part of the whole episode. On the day, expect to arrive fasting, have an IV placed, and be given sedation that puts you to sleep for a minute or two. Pads are placed on the chest and back, the shock is delivered, and more than one attempt is sometimes needed. People wake quickly and are watched on a monitor for a few hours before going home, with someone else driving. The skin under the pads can be red or sore for a day. Rhythm can return to fibrillation later, which is why this is sometimes repeated.

Questions worth asking

• Will an anesthesiologist or a sedation provider bill separately, on top of the hospital and cardiologist charges?
• Is this booked as an outpatient procedure, observation, or an admission? The three are paid very differently by most plans even when the day looks identical.
• If a transesophageal echocardiogram is done first to look for clot, is that a separate procedure charge on the same day?
• If the rhythm does not convert, or converts and then relapses within hours, is the attempt still billed in full?
• If this is likely to be repeated, is there a package or facility rate for subsequent attempts?